MEDICARE: ELEANOR BLAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WW0101X	Ambulatory Women's Health Care Registered Nurse	R096766	MD

General Provider Information

NPI Number	:	1356427975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR BLAND

Provider Business Mailing Address
First Line	:	3019 MONDAWMIN AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-1904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 WOODLAWN DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-4008
Country	:	US
Telephone Number	:	410-887-1332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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Directions to “ ELEANOR BLAND ” Practice Location

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